Community and provider perceptions and experiences of cervical cancer screening in Rural Bolivia: a qualitative study.

BACKGROUND: Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. METHODS: Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. RESULTS: Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members' lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. CONCLUSIONS: Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers' ability to perform screening.

Stingless bees: uses and management by meliponiculturist women in the Chaco region of Bolivia.

BACKGROUND: Stingless bees have a great value as main pollinators of wild flowering and cultivated plants, thus playing a fundamental role in the maintenance of biodiversity and food security in Latin America. Despite their importance, stingless bees face numerous threats causing alarming population declines. Moreover, stingless bees have a great cultural and traditional value, since most products from the hive are used for a wide variety of purposes. A growing number of initiatives are encouraging the breeding of these bees, through training courses and modern management techniques. This study documents the knowledge on stingless bees and their products that meliponiculturists from the Chaco region of Bolivia have, as well as the influence that meliponiculture initiatives have on the management and general knowledge of the bees. METHODS: Local richness and diversity of stingless bees was calculated using Hill numbers. Structured interviews were conducted with 59 meliponiculturists in order to characterize traditional and formal knowledge on stingless bees and meliponiculture. Generalized linear models were applied to assess the influence of training courses on the management of the bees. Also, a relative cultural importance index was calculated for each species. RESULTS: Twelve Meliponini species were identified, and 15 local names were reported with morphological, defensiveness behavior, and nest description. There was no significant difference in the knowledge between different ethnical backgrounds or ages. A significant difference was observed in the use of supplementary feeding and assisted division, but none in the success in racking hives or in pest management, regarding the number or courses taken. The relative cultural importance index recorded 30 specific uses for bee products grouped in four categories, from which 29 were attributed (but not exclusively) to Tetragonisca angustula, making it the most versatile species. CONCLUSIONS: The products of the hive, especially honey, are used for a wide variety of purposes, mostly in medicine. These uses are mostly attributed to just one species, T. angustula, in coincidence with what was taught in meliponiculture training courses by NGOs. The influence of formal knowledge is mostly positive, but it is recommended that other meliponini species are taken into account as well.

Community strategies for health promotion and prevention of chronic non-communicable diseases with a focus on physical activity and nutrition: the URO/FOCOS study protocol.

Non-communicable diseases (NCDs) account for 71% of all annual deaths, totaling 41 million people worldwide. The development and progression of these diseases are highly related to the environment and lifestyle choices, among which physical inactivity and excess malnutrition stand out. Currently, in Chile, there is no evidence at the regional and local level on the impact of physical activity and healthy nutrition plans and interventions on health promotion, prevention, and timely treatment of NCDs. The following protocol delineates the URO/FOCOS (Universidad Regional de O'Higgins/FOrtaleciendo COmunidades Saludables- Regional University of O'Higgins/Strengthening Healthy Communities) study, which will assess pilot community intervention strategies using a participatory action research approach by identifying barriers and facilitators on the practice of physical activity and healthy eating habits. In this project, the community from the O'Higgins region will be involved throughout the entire research process to develop strategies that promote regular physical activity and healthy eating practices. We propose three interrelated strategies: (1) Participatory Action Research, (2) Community interventions for promoting physical activity and healthy nutrition practices, and (3) health education. The URO/FOCOS study offers a unique opportunity in the O'Higgins region to develop participatory strategies and interventions based on the community's needs and motivations with regard to physical activity and healthy eating habits. We believe these strategies will help to improve the community's overall health through effective changes in their decision and preferences toward a more active lifestyle and healthier nutrition practices.

Response of Care Services for Patients with HIV/AIDS during a Pandemic: Perspectives of Health Staff in Bolivia.

The COVID-19 pandemic has caused an unprecedented crisis striking health services, generating risks of setbacks in health care and affecting the most vulnerable populations such as HIV patients. This study aims to explore the impact of the COVID-19 pandemic on the operational management of health services for people living with HIV/AIDS in Cochabamba, Bolivia. We applied a qualitative approach using semi-structured in-depth interviews with ten key health professionals who care for patients with HIV/AIDS in Cochabamba, Bolivia. Interviews were transcribed verbatim and uploaded to Atlas.ti software for analysis. We used an ethnographic approach within the interpretive paradigm to carry out the thematic analysis, considering the "Determinants of health systems resilience framework" of five dimensions developed by the World Health Organization. Even though the provision of services in public care services was not interrupted during the COVID-19 pandemic, health service delivery was severely affected. Digital technology could be used to compensate in urban areas. Regarding the distribution of medications, adaptative strategies to reduce patient complications were implemented. Unfortunately, the complementary tests availability was limited. The COVID-19 pandemic had a significant impact on HIV/AIDS patient care services in Cochabamba, with repercussions for HIV treatment access and virologic suppression.

Child-Focused Mental Health Interventions for Disasters Recovery: A Rapid Review of Experiences to Inform Return-to-School Strategies After COVID-19.

There is a worldwide need for mental health interventions to address the mental health needs of children under 12 who are returning to school in the post-COVID-19 environment. The basic characteristics of child-focused, post-crisis interventions are currently unknown, but they are essential for developing high-quality, expedient RTC programs. We conducted a rapid systematic review, via established PICO methodology, to appraise the characteristics of such interventions. We queried databases (PubMed, PsycInfo, ERIC) for English and Spanish publications describing mental health interventions to reduce mental health symptoms and sequelae among children exposed to disasters and other community crises. We described the following characteristics: type of intervention, length, number of sessions, number of staff delivering the intervention, and other characteristics. A total of 18 original articles met the inclusion criteria: 11 correspond to a controlled trial type of study and 15 addressed PTSD after disaster or crisis situations. Cognitive-behavioral therapy (CBT) was the most common intervention type, school-based/related interventions were the most common method, and five articles described an important role of teachers as mediators of therapy.

Courses on Basic Occupational Safety and Health: A Train-the-Trainer Educational Program for Rural Areas of Latin America.

Integrating basic occupational health services into primary care is encouraged by the Pan American Health Organization. However, concrete initiatives are still scarce. We aimed to develop a training program focusing on prevention of occupational risks for primary healthcare professionals. This train-the-trainer program was piloted at four universities in Chile and Peru. Occupational health or primary healthcare lecturers formed a team with representative(s) of one rural primary healthcare center connected to their university (Nparticipants = 15). Training started with a workshop on participatory diagnosis of working conditions. Once teams had conducted the participatory diagnosis in the rural communities, they designed in a second course an active teaching intervention. The intervention was targeted at the main occupational health problem of the community. After implementation of the intervention, teams evaluated the program. Evaluation results were very positive with an overall score of 9.7 out of 10. Teams reported that the methodology enabled them to visualize hazardous working conditions. They also stated that the training improved their abilities for problem analysis and preventive actions. Aspects like time constraints and difficult geographical access were mentioned as challenges. In summary, addressing occupational health in primary care through targeted training modules is feasible, but long-term health outcomes need to be evaluated.

Stigma towards people with mental disorders: perceptions of devaluation and discrimination in a sample of Chilean workers / Estigma hacia personas con trastornos mentales: percepciones de devaluación y discriminación en una muestra de trabajadores chilenos

Abstract Introduction Mental disorders represent one of the main causes of disease burden in the adult population. Negative public attitudes and behaviors toward people with mental disorders negatively affect the treatment, recovery, and social inclusion of those affected. Chile laks surveys on workers that address this issue. Objective To describe the perceptions of devaluation and discrimination towards people with mental disorders in a sample of Chilean workers. Method A cross-sectional study was carried out with 1 516 workers in the formal sector of four regions of Chile (Metropolitan Region [RM], Bío Bio [VIII], Valparaíso [V] and Coquimbo [IV]). The perception of discrimination and devaluation was explored through a modified version of the The perceived Devaluation-Discrimination Scale (PDD) comprising 15 questions. The relationship of each question with sociodemographic variables (age, sex, years of study, and region) and type of economic activity was assessed. Results The study found a high percentage of perceptions of devaluation and discrimination in most aspects considered, particularly those related to hiring a person who has been hospitalized due to a mental illness (85%), feeling sorry for people with severe mental illnesses (80%), and the unwillingness to marry a person with a mental illness (78%). Significant differences were observed in the opinions by sociodemographic variables and region of residence. Discussion and conclusion The perception of Chilean workers has high levels of stigma towards people living with mental disorders. It is necessary and urgent to develop effective anti-stigma public policies to promote a more inclusive, tolerant society.

Resumen Introducción Los trastornos mentales representan una de las principales causas de carga de morbilidad en la población adulta. Las actitudes y conductas públicas negativas hacia las personas con trastornos mentales inciden negativamente en el tratamiento, la recuperación e inclusión social de las personas afectadas. Chile no cuenta con encuestas en trabajadores que aborden este tema. Objetivo Describir las percepciones de devaluación y discriminación hacia personas con trastornos mentales en una muestra de trabajadores chilenos. Método Se realizó un estudio transversal con 1 516 trabajadores del sector formal de cuatro regiones de Chile (Región Metropolitana [RM], de Bío Bio [VIII], de Valparaíso [V] y de Coquimbo [IV]). Se exploró la percepción de discriminación y devaluación por medio de una versión modificada de la Perceived Devaluation-Discrimination Scale (PDD) con 15 preguntas. Se analizó la relación de cada pregunta con variables sociodemográficas (edad, sexo, años de estudio y región) y tipo de actividad económica. Resultados Se detectó un alto porcentaje de percepción de devaluación y discriminación en la mayoría de los aspectos considerados, destacándose los relacionados con la contratación de una persona que ha sido hospitalizada por una enfermedad mental (85%), sentir pena por las personas con enfermedades mentales graves (80%) y el rechazo a casarse con una persona que tenga una enfermedad mental (78%). Se observaron diferencias significativas en las percepciones, según las variables sociodemográficas y las relativas a la región de residencia. Discusión y conclusión La percepción de los trabajadores en Chile muestra altos niveles de estigma social hacia personas con trastornos mentales. Es necesario y urgente desarrollar políticas públicas antiestigma efectivas, promoviendo al mismo tiempo una sociedad más inclusiva y tolerante.

Relación de trabajo y autopercepción de salud en estudiantes de Enfermería en Sucre, Bolivia / Relationship between work and self-perceived health among nursing students from Sucre, Bolivia

Introducción: Diversos estudios han reportado el alto estrés percibido por los estudiantes universitarios, tanto debido a las demandas académicas como a los aspectos financieros o familiares. En ese sentido, existe muy poca información sobre el efecto que el trabajo podría tener en la salud de los estudiantes de Enfermería en Latinoamérica. Objetivo: Caracterizar la relación entre trabajo y autopercepción de salud en estudiantes de Enfermería de la Universidad "San Francisco Xavier" de Chuquisaca, Bolivia. Método: Se realizó un estudio transversal en 126 estudiantes de tercer año (respuesta 83,4 por ciento). Se aplicó un cuestionario autoadministrado, que exploró características sociodemográficas, económicas, estilos de vida, apoyo social, trabajo actual y autopercepción de salud. Se calcularon los Odds Ratios crudos y ajustados con su intervalo de confianza del 95 por ciento, a través de los modelos de regresión logística. Resultados: El grupo de estudiantes que participó estuvo conformado, en su mayoría, por mujeres, menores de 24 años, solteros, los que vivían con familia o amigos, y los que presentaban estrés financiero bajo o medio. En el modelo ajustado, los estudiantes que trabajaban (Odds Ratio ajustado 5,6; 95 por ciento Intervalo de confianza 2-17,9) y aquellos que reportaron haber sufrido de estrés financiero los últimos doce meses (3,6; 1,4-8,9) resultaron más propensos a percibir su salud de forma negativa. Conclusiones: La condición adicional de trabajador, así como la presencia de estrés financiero durante la formación profesional, constituyen factores importantes que influyen en la autopercepción de salud de estudiantes de Enfermería. Es necesario considerar estrategias institucionales que apoyen a los estudiantes trabajadores para mejorar su autopercepción de salud, así como la calidad educativa y su desempeño profesional(AU)

Introduction: Various studies have reported the high stress levels perceived by university students, which are caused by academic demands as well as financial or family problems. Very little information is available about the potential effect of work on the health of Latin American nursing students. Objective: Characterize the relationship between work and self-perceived health among nursing students from San Francisco Xavier University in Chuquisaca, Bolivia. Method: A cross-sectional study was conducted of 126 third year students (response 83.4 percent) based on a self-applied questionnaire exploring sociodemographic and economic characteristics, lifestyle, social support, current job and self-perceived health. Crude and adjusted odds ratios were estimated with a 95 percent confidence interval using logistic regression models. Results: Most of the students participating in the study were female, aged under 24 years, single, living with their family or friends, and under low or medium financial stress. In the adjusted model, students who worked (adjusted odds ratio 5.6; 95 percent confidence interval; 2-17.9) and those reporting having been under financial stress in the last twelve months (3.6; 1.4-8.9) were the most prone to have a negative perception of their own health. Conclusions: The additional condition of worker and the presence of financial stress during professional training, are important factors affecting health self-perception among nursing students. Institutional strategies should be considered in support of working students to improve their health self-perception, the quality of instruction and their professional performance(AU)

Associations between effort-reward imbalance and health indicators among school teachers in Chuquisaca, Bolivia: a cross-sectional study.

OBJECTIVE: To assess the association between effort-reward imbalance (ERI) and health indicators among Bolivian school teachers. DESIGN: School-based cross-sectional study. SETTING: Sixty randomly selected schools from rural (33) and urban (27) schools in Chuquisaca, Bolivia. PARTICIPANTS: A total of 1062 school teachers were invited to participate, of which 597 answered the questionnaire (response 56.2%). EXPOSURE MEASURE: Psychosocial factors at work were explored through the short version of the Effort-Reward Questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: Health outcomes included self-rated overall health, mental distress (12-item General Health Questionnaire ≥5) and the 7-day prevalence of low back pain (LBP) as well as neck or shoulder pain (Nordic Questionnaire). Crude and adjusted ORs and their 95% CIs for each health outcome were calculated using logistic regression models. RESULTS: The median value for the effort-reward ratio was 0.91 (range: 0.3-2.3) with higher values for teachers from rural versus urban schools. Overall, about 43% of the teachers reported their overall health as fair or poor; 45% suffered mental distress, 17% reported LBP and 29% neck or shoulder pain. Prevalences were higher for teachers employed at rural schools compared with those at urban schools. After adjusting for potential confounders and school location, ERI was statistically significantly associated with fair/poor self-rated health (adjusted OR 1.7, 95% CI 1.0 to 2.9); mental distress (1.9; 95% CI 1.2 to 3.1) and LBP (2.3; 95% CI 1.3 to 4.1). CONCLUSION: Our results indicate the urgent need to improve psychosocial working conditions among Bolivian school teachers, in order to promote their health and well-being.

Leishmaniasis: Who Uses Personal Protection among Military Personnel in Colombia?

BACKGROUND: Leishmaniasis is common in Colombia, negatively affecting the health of military personnel active in endemic areas. The disease is transmitted by sand fly bites. Therefore, during duty, use of long-sleeved uniforms and other clothes treated with permethrin and application of mosquito repellent are important personal preventive measures. OBJECTIVE: The objective of this study was to assess personal and occupational factors associated with the use of personal protection in male soldiers deployed to Leishmaniasis-endemic areas. METHODS: Three hundred soldiers participated in a cross-sectional questionnaire study (response 84.3%). The self-administered questionnaire contained questions about sociodemographics, duration of service, compliance with personal mosquito protection, and knowledge about leishmaniasis. Descriptive analyses were followed by multiple logistic regression models adjusted for potential confounders (EpiInfo Version 7.0) FINDINGS: Overall, 23% of the soldiers reported complete use of the recommended personal protection measures. About 83% of the participants had heard about leishmaniasis. In the adjusted regression model, knowledge about leishmaniasis (adjusted odds ratio = 2.9; 95% confidence interval: 1.1-7.2) and being enrolled in the army for more than 5 years (2.2; 1.1-4.1) increased the odds of using personal protection. CONCLUSIONS: Improving knowledge about leishmaniasis is one measure to increase use of personal protection, thereby diminishing the risk of infection.

Prevalence of musculoskeletal disorders among school teachers from urban and rural areas in Chuquisaca, Bolivia: a cross-sectional study.

BACKGROUND: Musculoskeletal disorders (MSD) are important health problems in working populations. The study aimed to determine the prevalence of MSD among school teachers from urban and rural areas in Chuquisaca, Bolivia. METHODS: A cross-sectional study was conducted in 60 randomly selected schools. In total, 1062 teachers were invited to participate (response 58%). The Spanish version of the Standardized Nordic questionnaire was used assessing the 12-months and 7-days prevalence of MSD as well as the 12-months prevalence of work limiting pain. Prevalence were calculated for the different parts of the body; as summary measures, MSD in any part of the body and in ≥3 parts of the body were assessed. Crude and adjusted odds ratios with 95% confidence intervals were calculated using logistic regression models adjusting for age, sex, teaching level and school type. RESULTS: Prevalence of MSD in any part of the body was 86% during the last 12 months, 63% during the last 7 days and 15% for work limiting pain. MSD was most common in the neck (12-months prevalence 47%) and least common in the wrist/hands (26%). In the adjusted model, teachers working in rural areas presented significantly higher odds than teachers from urban schools for work-limiting pain during the last 12-months considering any part of the body (aOR 2.2; 95% CI 1.1-4.1), and for ≥3 parts of the body (aOR 3.7; 95% CI 1.3-10.6). CONCLUSION: The prevalence of MSD is high in School teachers, even more in teachers working in rural areas. It is needed to identify risk factors for MSD in teachers in order to propose appropriate strategies to control and reduce it.

Prevalence of asthma, rhinitis and eczema symptoms in rural and urban school-aged children from Oropeza Province - Bolivia: a cross-sectional study.

BACKGROUND: Asthma and allergies are world-wide common chronic diseases among children and young people. Little information is available about the prevalence of these diseases in rural areas of Latin America. This study assesses the prevalence of symptoms of asthma and allergies among children in urban and rural areas at Oropeza Province in Bolivia. METHODS: The Spanish version of the ISAAC standardized questionnaire and the ISAAC video questionnaire were implemented to 2584 children attending the fifth elementary grade in 36 schools in Oropeza province (response 91%). Lifetime, 12 months and severity prevalence were determined for asthma, rhinitis and eczema symptoms. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated adjusting for age using generalized linear mixed-effects models. RESULTS: Median age of children was 11 years, 74.8% attended public schools, and 52.1% were female. While children attending urban schools had lower prevalence of self-reported wheeze in the written questionnaire (adjusted OR 0.6; 95% CI 0.4-1.9), they were more likely than children attending rural schools to report wheeze in the video questionnaire (aOR 2.1; 95% CI 1.0-2.6). They also reported more frequently severe rhinoconjunctivitis (aOR 2.8; 95% CI 1.2-6.6) and severe eczema symptoms (aOR 3.3; 95% CI 1.0-11.0). CONCLUSION: Overall in accordance with the hygiene hypothesis, children living in urban areas of Bolivia seem to have a higher prevalence of symptoms of asthma and allergies compared to children living in the country side. In order to develop primary prevention strategies, environmental factors need to be identified in future studies.

Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province--Bolivia: a cross-sectional study.

BACKGROUND: In recent years, the prevalence of asthma, rhinoconjunctivitis and eczema symptoms in childhood has considerably increased in developing countries including Bolivia, possibly due to changes in lifestyle, environmental and domestic factors. This study aimed to assess the association between environmental factors and asthma, rhinoconjuctivitis and eczema symptoms in school-aged children from Oropeza Province in Chuquisaca, Bolivia. METHODS: A cross-sectional study was performed in 2340 children attending the fifth grade in 36 randomly selected elementary schools in Oropeza province. The prevalence of symptoms was determined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Environmental factors were assessed by the ISAAC environmental questionnaire including questions related to exposure to pets, farm animals, indoor and outdoor pollution, presence of disease vectors at home and precarious household conditions. Generalized linear mixed-effects models were adjusted for age, sex and place of living. RESULTS: Thirty seven percent of children reported that at least one of their parents smoked at home. Wood or coal was used as cooking fuel in 19% of the homes and 29% reported intense truck traffic on the street where they lived. With respect to hygiene conditions, 86% reported exposure to dogs, 59% exposure to cats and 36% regular contact to farm animals. More than one precarious household condition was reported by 8% of children. In the adjusted model exposure to dog (adjusted OR 1.4; CI 95% 1.0-1.9), cat (1.2; 1.0-1.5), farm animals (1.5; 1.2-1.8); intense truck traffic (1.3; 1.0-1.6), parents smoking at home (1.2; 1.0-1.5), presence of disease vectors at home (fourth quartile vs. first quartile: 1.6; 1.2-2.3) and two or more precarious household conditions (1.5; 1.0-2.2) were significantly associated with rhinoconjunctivitis symptoms. The associations were similar for asthma and eczema symptoms; however it did not reach the level of statistical significance for all items. CONCLUSION: Our results support previous findings reported for poor communities especially in Latin America, showing that lower hygiene conditions did not have protective effect against asthma and rhinoconjunctivitis and eczema symptoms.